HIVST among children, adolescents and pregnant and breastfeeding women: implementation results and enablers for scale-up

BACKGROUND: In 2020, ART coverage was 44% for children and 45% for pregnant women living with HIV in Nigeria. Since 2016, WHO has recommended HIV self-testing (HIVST) for under-reached populations, and in 2019, approved use among children aged 2-11 years by trained professionals. National guidelines for HIVST further allow caregiver-assisted testing; however, HIVST for all populations is limited. CHAI is supporting the Federal Ministry of Health (FMoH) to demonstrate effective HIVST delivery models and identify enablers for scale-up.
METHODS: Between April- December 2021, CHAI and FMoH supported training and commodities for HIVST among children aged 2-11 of index clients via HIV testing services (HTS) officers at 9 facilities, adolescents/ young people (AYP) via adolescent champions at 9 Adolescent and Youth Friendly Centers (AYFC) and pregnant and breastfeeding women (PBFW) via 8 traditional birth attendants (TBAs) in Anambra and Akwa-Ibom states. Data collected included client demographics, testing history, HIVST mode, results, confirmatory testing and ART linkage from FMoH monthly summary forms and operational insights from CHAI-led learning sessions.
RESULTS: Across models, 2,100 HIVST kits were distributed and 2,049 (98%) utilized. Thirty-eight (2%) clients self-reported reactive results, 32 (84%) received confirmatory testing and 32 (1.6%) were identified HIV-positive (Table).Yields were 0.9%, 2.9% and 1.8% in facility index testing, AYFC and TBA models respectively, and all were linked to ART. Overall, 95% of tests were for first-time testers and 94% were conducted with assistance by distributors. At AYFCs, 34% of HIVST kits were collected for secondary use. Distributors and target populations recommended community sensitization, incentives such as condoms, additional distribution points and resources for follow-up to improve uptake and confirmatory testing.

Distribution Model	HIVST Kits Distributed	HIVST kits distributed for secondary use	HIVST kits distributed for First- Time Testers	HIVST Conducted	HIVST Assisted by Distributor	Results Reported	Reactive Results	Clients receiving Confirmatory Tests	Clients Identified HIV-Positive	Clients Linked to ART
Facility index testing for children aged 2-11	1,100 (52%)	n/a	1,100 (100%)	1,054 (96%)	1,054 (100%)	1,023 (97%)	10 (1%)	9 (90%)	9 (0.9%)	9 (100%)
AYFC for AYP and their peers	451 (21%)	152 (34%)	443 (98%)	446 (99%)	330 (74%)	443 (99%)	13 (3%)	13 (100%)	13 (2.9%)	13 (100%)
TBA for PBFW	549 (26%)	n/a	444 (81%)	549 (100%)	542 (99%)	549 (100%)	15 (3%)	10 (67%)	10 (1.8%)	10 (100%)
Total	2,100		1,987 (95%)	2,049 (98%)	1,926 (94%)	2,015 (98%)	38 (2%)	32 (84%)	32 (1.6%)	32 (100%)

CONCLUSIONS: Decentralized, peer-driven models for HIVST can be effective for testing, including adolescent social network testing, and ART linkage; however, uptake was low and further research is needed on improving yields among children. To optimize impact, HIV programs should leverage existing venues and cadres serving target populations, prioritize demand generation and train distributors to provide support aligned with client preferences.

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